swallowing disorders: tracheostomy tubes part 2

Question 1

what is a fenestrated tube?

Answer 1

has a window cut into tube to allow for greater airflow

Question 2

where is fenestration?

Answer 2

usually only to the outer cannula (so remove inner cannula if you want pt to talk)

Question 3

when is fenestrated tube used?

Answer 3

when pt’s have difficulty producing voice with a normal trach tube or they are close to being weaned from tube

Question 4

is it common or rare for cuffed tracks to be fenestrated?

Answer 4

rare because it negates what a cuff does

Question 5

how do you wean off a trach tube?

Answer 5

decrease size (diameter) of tube
may also use plug or cap to see how pt is functioning with normal respiration
(plug/cap shuts air off, so are they breathing? O2 sats normal?)

Question 6

speaking valves: caps/plugs

Answer 6

inserted into trach tube to force normal respiration and voicing

Question 7

speaking valves: one-way

Answer 7

common type: passy muir valve

allows air in through tube but not out, forcing it up through VF’s allowing voice to be produced

Question 8

speaking valves: how/when used (3)

Answer 8

as part of weaning process
to create closed pressure system
as tolerated by patient

Question 9

how to test swallow with someone who has a trach

Answer 9

deflate the cuff
finger occlusion to check for voicing/speech
suction is cuff has not been deflated
if no voicing, not ready for swallowing (failed swallow assessment)
explain to MD: not ready for swallow bc can’t voice
if diameter is size 8 or above, usually means can’t get voicing- hole is too big

Question 10

blue dye test: bedside swallow eval where dye food blue

Answer 10

perform bedside swallow eval as usual but add blue food coloring to all consistencies

Question 11

blue dye test: must do what?

Answer 11

deflate the cuff

Question 12

blue dye test: how accurate?

Answer 12

40-50%

Question 13

blue dye test: suction when?

Answer 13

immediately after swallow, then 10 mins later, then 20-30, etc.

Question 14

blue dye test: if medically/physically able, do what?

Answer 14

an MBS or FEES

Question 15

blue dye test: if suction and see blue dye, this means what?

Answer 15

they aspirated

Question 16

ventilator dependence is aka _____

Answer 16

mechanical ventilation

Question 17

goals of ventilator dependence

Answer 17

to maintain alveolar ventilation appropriate to patient’s metabolic requirements
to correct hypoxemia

Question 18

problems with speech and swallowing when ventilator dependent

Answer 18

difficulties coordinating speech or swallowing with breathing cycle for ventilator
difficulty with short exhalation cycle of ventilator
cuff is usually inflated

Question 19

assessment process when ventilator dependent

Answer 19

best to focus on speech before swallowing

present food at beginning of exhalation